Frailty update Hot Topics Shutdown - definition Stop thinking of older people as having collections of diseases Consider frailty as a medical syndrome with a more holisitic view to manage in a pro-active way

Frailty tidal wave

Frailty – the WECCG challenge What do we commission? Integrated community teams Rapid response Reablement Hospice at home Night care Community beds Frailty Assessment Service

Frailty – the facts •48% of people over 85 die within one year of hospital admission Imminence of death among hospital inpatients: Prevalent cohort study David Clark, Matthew Armstrong, AnandaAllan, Fiona Graham, Andrew Carnonand Christopher Isles, published online 17 March 2014 PalliatMed •10 days in hospital (acute,subacute or community) leads to the equivalent of 10 years ageing in the muscles of people over 80 –Gill et al (2004). studied the association between bed rest and functional decline over 18 months. They found a relationship between the amount of time spent in bed rest and the magnitude of functional decline in instrumental activities of daily living, mobility, physical activity, andsocial activity. –KortebeinP, Symons TB, FerrandoA, et al. Functional impact of 10 days of bed rest in healthy older adults. J GerontolA BiolSciMed Sci. 2008;63:1076–1081.

Frailty scores Frailty scores on discharge letters Frailty scores on outpatient clinic letters Frailty score eFI in EMIS and SystmOne

Frailty scores

Frailty scores

Frailty scores – why?

Princess Alexandra Hospital Frailty Assessment Service (FAS) Dr Alfa Sa’adu Dr David Tideswell

Aim of the Frailty service @ PAH To provide a more comprehensive specialty focused service for our older patients To reduce the number of our older population spending a long time in the Emergency Department To facilitate a reduction in length of stay for patients and enable them to return home sooner with the right care

Inclusion Criteria over 75 years Clinical Frailty Score of ≥4. Patients presenting with falls/reduced mobility/breakdown of package of care/dehydration/UTI/Constipation/SOB/COPD/ chest infection/confusion/dementia Patients requiring pain/pharmacy management

Exclusion Criteria Patients who can be treated within the community via Single Point of Access Patients who clinically need an acute admission ie #NOF, head injury Patients who could be directly admitted to a Community hospital

The Frailty Score PAH Frailty Service is for patients with a >4 frailty score

Frailty Assessment Unit Service commences Monday 17th October 2016 Located within PAH on ward B40 Open 09:00 – 17:00 Monday – Friday Patients accepted via GP Co-ordinator or from PAH Emergency Department via bleep 755 The team: Frailty Lead – Janice Bernardo (3/10/16) Frailty Consultant – Dr Azad Harripaul Frailty General Manager – Ali Hearn Ward Manager – Peter Robinson Therapies support – Susan Fullen

How do you refer? Contact PAH GP hotline – 01279 652556 and ask for the medical GP Co-ordinator. You will need the following information regarding your patient: What is their Frailty score? What are their current obs? What is the referral reason? Is the patient able to make their own way to PAH? Have you considered all alternative community pathways via single point of access?

QUESTIONS?